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Individual drinking habits may be found on a continuum from responsible drinking through alcohol abuse to alcoholism, or physical dependence.

There are many signs that may point to an alcohol problem. Drunkenness on its own or solitary drinking does not necessarily indicate alcoholism. The questionnaire will be meaningful to you only if you are honest with yourself when taking it.

The important question is: Is your use of alcohol creating significant negative consequences in your life?

Do you sometimes drink heavily after a setback or an argument, or when you receive a poor grade?

When you experience trouble or are undergoing stress, do you always drink more heavily than usual?

Can you handle more liquor now than you could when you first began drinking?

Have you ever awakened the “morning after” and found that you could not remember part of the evening before, even though your friends said that you didn’t pass out?

When drinking with others, do you try to have just a few additional drinks when they won’t know of it?

Are there times when you feel uncomfortable if alcohol isn’t available?

Have you noticed lately that when you start drinking you’re in more of a hurry to get to the first drink than you used to be?

Do you sometimes have negative thoughts or feelings about your drinking?

Are you secretly irritated when your friends or family discuss your drinking?

Do you often want to keep drinking after your friends have said that they’ve had enough?

When you’re sober, do you often regret things you have done or said while drinking?

Have you tried switching brands or following different plans for controlling your drinking?

Have you often failed to keep promises you have made to yourself about controlling or cutting down on your drinking?

Do you try to avoid your girlfriend/boyfriend when you are drinking?

Are you having an increasing number of school, work, or financial problems?

Do more people seem to be treating you unfairly without good reason?

Do you eat very little or irregularly when you’re drinking?

Do you sometimes have the “shakes” in the morning and find that it helps to have a drink?

Have you noticed lately that you cannot drink as much as you once did?

If you can answer “yes” to several of these questions, your drinking is causing problems for you and professional consultation can help prevent problems from getting more intense or numerous. Additionally you may find help at Alcoholics Anonymous.

Some people resolve to curb their drinking and can do so for a time only to have their alcohol problems persist or reoccur. The drinking habits of alcohol abuse or alcoholism can become very entrenched.

1. Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

3. Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.

9. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

Building Healthy Relationship With One’s Self In Al-Anon

As a family recovery coach, my radar goes up when I hear clients talking about how much someone else’s drinking is bothering them. What the drinker’s actual diagnosis is or isn’t, is not important to me. If their drinking is bothering my client, I gently begin asking questions to help me better understand just how much of a problem it is to my client. Often, these conversations lead me to put Al‑Anon on my list of recommendations for the client.

You may wonder why I want my clients to go to Al‑Anon, when I’m specially trained to help the family members of alcoholics. The short answer to that question is that Al‑Anon works.

The people who have been going to Al‑Anon meetings for a very long time have discovered the secret of living well and enjoying their own lives whether their alcoholic relatives choose sobriety or not.

The clients I’ve sent to meetings progress faster toward the coaching goals they have set, become more able to deal with other aspects of their lives more effectively, and grow happier over time, regardless of their alcoholic’s choices.

I work hand in hand with the Al‑Anon program and its Twelve Steps because Al‑Anon facilitates the re‑emergence of inner health on the outer level. Al‑Anon is the program of relationships, beginning with building a healthy relationship with one’s self. And more than anything else, those related to alcoholics need support in rebuilding a healthy relationship with themselves because that’s where family recovery begins.

The truth is that most people, including addicts themselves, have no idea what addiction really is. When being honest, the addict will tell you that he or she has no better an understanding of the problem than you have. Addiction confounds us; it frustrates us; it scares us. This has been the way it’s been since time immemorial. That’s why for millennia the only response to the town drunk was either to lock him up for good or to allow him to run raving in the streets. How else should one deal with a problem that makes no sense?

Most people, including addicts themselves, have no idea what addiction really is.

There is an old Jewish saying: “Knowing the disease is half the cure.” (Yes, the rabbis have been saying that for centuries already.)

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Can the AA 12-Step Program Thrive in Russia?

The US Helsinki Commission is charged with monitoring human rights compliance in the former Soviet Union. But on August 2, the commission took a break from its routine responsibilities to examine the thorny issue of alcoholism in Russia.

Russians’ capacity for drink is legendary. During the hearing, titled US-Russian Cooperation in the Fight against Alcoholism, one of the witnesses, Heidi Brown, an analyst at Kroll Associates, tried to quantify the impact of spirits on Russian society. The numbers she proffered were alarming: half-a-million deaths each year in Russia are alcohol-related, and approximately half of all male deaths in Russia are in some way connected to excessive alcohol consumption. In addition, a whopping 2.3 billion liters of vodka are sold every year in Russia, a country with a current estimated population of 142 million.

Another witness at the hearing was Dr. Eugene Zubkov, the co-founder of a 30-bed clinic in Leningrad Oblast outside St. Petersburg that specializes in treating alcoholics. Zubkov noted that there are 2.7 million officially registered alcoholics in Russia, but added that the official count was probably low. “It means probably three times that many patients … are not registered,” he said. If Zubkov’s estimate is accurate, it means that approximately one in every 13 Russian citizens may be an alcoholic.

The hearing spent a fair amount of time examining the applicability to Russia of the 12-step program developed by Alcoholics Anonymous (AA), a mutual assistance movement designed to promote sobriety that was founded in 1935 in the United States.

Margaret Murray, the director of the International Research Program at the US National Institute on Alcohol Abuse and Alcoholism, told members of the Helsinki Commission that AA “has been an extremely important mainstay of [alcoholism] treatment in the United States.” Among the benefits, Murray said, was the “social support for abstinence that AA provides, as well as enhancing an individual’s spirituality, which we know is key to recovery for a lot of people.”

Zubkov said his clinic, called the House of Hope on a Hill, utilizes AA’s 12-step method in its 28-day treatment program. Since its opening in 1996, the House of Hope has treated about 4,500 patients, he said, adding that the facility has acted as a catalyst for the slow spread of AA chapters across Russia. “There are now 370 AA meetings … in Russia, and 40 percent of those meetings were started by – initiated by the graduates of the house,” he said.

AA encounters lots of opposition in Russia, Zubkov noted. Efforts to open an AA-based clinic in a new location often generate official opposition because the 12-step method is seen as a foreign import.

“There is a lot of mistrust of Alcoholics Anonymous there because it is seen as Western. … There are a lot of people who still have sort of a nationalism or a resentment about methods that have come from abroad,” added Brown. Some opposition also appears to be faith-based, as AA is seen by many Orthodox Christian Russians as essentially a creature of the Reformed Protestant tradition.

Preferred treatment methods in Russia lack an adequate after-care component, Zubkov said. “Russian treatment methods are largely very biologically oriented and sometimes strange.” The most popular method relies on the use of Antabuse, a drug that makes people sick when they drink alcohol. But this does not address the cultural and physical sources of the addiction. “And after this, [the] patient is basically – he is on his own,” Zubkov said. “He doesn’t get any therapeutic support. He doesn’t get any – he doesn’t go to any meetings. And when he has a personal crisis, the easiest way for him to resolve it is try to drink, and very often this could end in fatalities.”

Beyond cultural differences, the lack of a tradition of philanthropic giving in Russia is hampering the ability of AA programs to expand their reach. The House of Hope, Zubkov noted, depended on financial support provided by an American philanthropist, Lou Bantle, who died in 2010. Now, the clinic is facing an uncertain financial future. Finding Russian benefactors is an extreme challenge, Zubkov added.

Not only does the Russian government tax charitable contributions, but those corporations and philanthropists that do donate “prefer to support high-profile, socially acceptable organizations, such as the performing and visual arts.” The only exception has been the Baltika brewery, which has been “continuously supporting us for many years,” he said.